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LATEST NEWS UPDATES | Battle brews over barefoot doctors by GS Mudur

Battle brews over barefoot doctors by GS Mudur

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published Published on Feb 2, 2010   modified Modified on Feb 2, 2010

India’s largest association of doctors and the country’s apex regulator of medical education appear poised for confrontation over a government proposal to create a new cadre of healthcare providers for rural areas.

The Union health ministry has announced a plan to create a group of health practitioners who could diagnose and treat common illnesses and injuries and prescribe medicines to patients in rural areas plagued by shortages of doctors.

The health ministry has asked the Medical Council of India (MCI) -- the apex regulator of medical education -- to design the syllabus for the proposed three-and-a-half year Bachelor of Rural Medicine and Surgery (BRMS) programme.

Proponents of the plan say the health ministry backing now appears to have pushed India closer than ever to the idea of an alternative health education plan that emerged nearly a decade ago, and has been pursued only by three states -- Chhattisgarh, Assam and Bengal.

The MCI has called a meeting of state medical education officers and senior faculty in New Delhi on Thursday to discuss strategies to implement the plan.

But the Indian Medical Association (IMA), claiming to represent some 180,000 doctors across the country, is launching a campaign to oppose the alternative health education programme.

“This plan will only produce substandard, half-baked doctors who will be able to deliver poor quality of healthcare,” Goparaju Samaram, a general practitioner in Vijayawada and national president of the IMA, told The Telegraph.

The IMA has pencilled a memorandum criticising the alternative health education proposal, contending that it would promote dual standards of medical care -- superior care in urban India and substandard care for the rural masses.

Surveys suggest that three-fourths of India’s estimated 700,000 MBBS-graduate doctors live in or around urban areas, serving less than 30 per cent of the country’s population. None of India’s 145,000 rural health sub-centres has any doctors.

“The rural health practitioners will fill a total vacuum,” said Kunchala Shyamprasad, a cardiothoracic surgeon and member of a government task force on medical education that resurrected the idea of an alternative course three years ago.

Although the Union health ministry has in the past often discussed the option of mandatory rural service for doctors before they earn a MBBS degree, the plan has remained unimplemented.

Proponents of the alternative health education plan point out that several countries in Asia and Africa have addressed doctor shortages through similar plans. India itself used to have a short-term course but it was abandoned.

“All we want is someone who can diagnose and treat severe respiratory infections, diarrhoea or malaria to be within 30-minute walking distance from every village home,” said Meenakshi Gautham, a public health specialist who has filed a petition seeking the implementation of an alternative health course for rural health practitioners.

“MBBS graduates are clearly not interested in rural areas,” said a mission director with the National Rural Health Programme. Health officials cite their recent experience in Chhattisgarh which had advertised for nearly 1,200 posts of MBBS graduates to fill positions in primary health centres. The state received only 400 applications.

“We aren’t able to spend the funds allocated for doctors’ salaries,” a state official said.

Education regulators concede that India's medical education system has failed to prepare its medical graduates to work in rural areas that lack infrastructure and facilities available in urban hospitals.

MCI president Ketan Desai said even students from rural India preferred to stay back in cities. “After nine to 13 years of medical education in Delhi, which graduate would want to go and work in Gorakhpur?” asked Desai.


The Telegraph, 3 Februaury, 2010, http://www.telegraphindia.com/1100203/jsp/frontpage/story_12060532.jsp
 

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